The toes burn and tingle and sharp pains shoot into your legs. The bed sheets feel
uncomfortable on the feet as you toss and turn, trying to get some rest. Your feet felt
numb throughout the day, but now feel like they are on fire. Nothing seems to help as you
watch the hours on the clock pass by, hoping to fall asleep.

Burning, numbness,
tingling, hot and cold sensations, shooting and electrical pain are common sensations felt
at rest in painful peripheral neuropathy. Neuropathy is an abnormality of the nervous
system. There are many different types of neuropathy, but the most common neuropathy
effecting diabetics is peripheral neuropathy.

Diabetic neuropathy is described as a loss of sensation that starts in the tips of the
toes and gradually works its way up the legs, and in severe case into the hands. It is
sometimes referred to as a stocking glove neuropathy because it progresses as if one was
pulling on a stocking.

Sixty percent of diabetics have some type of neuropathy in their feet. Five percent of
diabetics will experience painful diabetic neuropathy and the incidence increases with
age. Over 45% of individuals who have had diabetes for over 25 years will experience some
symptoms of painful diabetic neuropathy.

The cause of diabetic neuropathy is not clearly understood. Many believe that the
damage to the small vessels surrounding the nerves, from the diabetes, causes damage to
the nerves. Others believe the increase in blood sugar causes damage to the nerves.
Despite the different theories, studies have shown better blood sugar control helps
prevent progression of the neuropathy.

There are currently no treatments to help reverse diabetic neuropathy. There are no
treatments which help reduce the numbness. But, there are many treatments to help decrease
the pain associated with the neuropathy.

Your doctor may prescribe medications to help with the pain. There are many options,
but until recently none were FDA approved for the treatment of painful neuropathy.
Cymbalta®, duloxetine HCl, was recently approved by the FDA in September of 2004 for use
in diabetic peripheral neuropathy at doses of 60 and 120 mg per day. This is the first
drug approved for this use. Similar medications, like amitriptyline, desipramine and
nortriptyline, have been used to help decrease pain and help with sleep.

Gabapentin, also known as Neurontin®, has been a successful treatment for painful
diabetic neuropathy. Neurontin® was originally approved by the FDA for adjunctive use in
seizures, but the benefits of this drug for other conditions, like neuropathy, soon became
known. The manufacturers of Neurontin® were caught up in a controversy regarding their
marketing tactics for this off label use. Many physicians still use this drug despite the
controversy. Tegretol and Dilantin, common seizure medications, can be used in more severe
cases. New treatments include lidocaine 5% cream, acetyl-L-canitine, nerve growth factor
and Annodyne ®, infrared therapy.

To help treat painful peripheral neuropathy without prescription medications, consider
the following tips:

1. Keep your blood sugar in control: Studies have shown that when blood sugars remain
high, or roller coaster from high to low, peripheral neuropathy will worsen.

2. Exercise. This is probably the last thing you wanted to hear. Exercise helps
increase circulation and stimulates the growth of new vessels which help slow the
progression of the neuropathy. Exercising also helps to increase your pain threshold and
to provide a distraction from the nerve pain in your feet.

4. Try red pepper powder. Capsaicin is the active ingredient in chile peppers. When
applied to the feet it acts as a counter-irritant and can help decrease neuropathic pain.
Capsaicin can be purchased at your local drug store. If you cannot afford capsaicin, try
mixing 1 tablespoon of dry chile powder with 2 tablespoons of baby powder. Place the
mixture in a sock and use the socks at night.

5. Try alpha lipoic acid. ALA is an effective anti-oxidant that has been shown to
relieve pain associated with neuropathy in multiple studies. To help relieve pain, the
dose must be at least 600mg a day. It is advisable to start with a lower dose, as higher
doses can cause nausea, stomach upset, fatigue, insomnia and can lower blood sugar. In
general, ALA is a safe supplement.

6. Try gamma linolenic acid. GLA is an essential fatty acid found in evening primrose
oil. Most of the studies have shown modest results, but the possibilities are still
encouraging. Take 360mg/day. Many indications require higher dosages, but side effects
with long term use at higher doses may include inflammation, thrombosis (blood clots), or
decreased immune system functioning.

Treating painful diabetic peripheral neuropathy is very difficult and many of the above
mentioned therapies should be tried and combined. Don't expect any "cures" and
make sure you give each therapy a chance to work.